Domenici’s Legacy: Expanded Mental Health Coverage

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By Jacklyn Wille

Pete Domenici, a six-term Republican U.S. senator from New Mexico, died Sept. 13, nearly nine years after the mental health parity law he championed was signed into law.

Domenici, whose daughter Clare was diagnosed with schizophrenia, was one of the driving forces behind the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which was signed by President George W. Bush. The law is aimed at increasing patients’ access to mental health and substance abuse services by requiring health plans sponsored by companies with more than 50 employees to cover those services on the same terms as medical and surgical treatments. Among other things, the law prevents health plans from imposing more restrictive treatment limitations or cost-sharing requirements on mental health benefits than those that apply to medical or surgical benefits.

The MHPAEA is enforced largely by the plaintiff-side attorneys who bring lawsuits against insurers and health plans under the Employee Retirement Income Security Act. While the Labor Department’s Employee Benefits Security Administration is charged with enforcing the law—conducting 1,515 investigations and citing 171 violations between October 2010 and January 2016—the agency lacks authority to “directly take action against health insurance issuers” for parity act violations, according to a 2016 report to Congress.

Nearly 10 million U.S. adults have a serious mental illness and more than 43 million report some form of mental illness, according to 2014 data compiled by the Substance Abuse and Mental Health Services Administration. More than 20 million adults have problems with drug or alcohol dependence or abuse, according to the same data.

Law ‘Literally Saved Lives’

Brian S. King is a Utah-based attorney who has filed more than two dozen lawsuits in the past year against health insurers, including Cigna, United Healthcare, and Aetna, challenging their decisions to deny coverage mental health treatments received by minors. King said the MHPAEA is a critical law that helps people access necessary resources and remain productive citizens.

“When you have greater access for people to get these resources through employer health plans, it reduces our incarceration levels and increases tax receipts, because folks are able to work and get the treatment they need, when previously they would have been incapacitated,” King told Bloomberg BNA.

King, who’s been practicing in this area for about 20 years, said the MHPAEA has increased access to mental health services because it’s increased the availability of insurance coverage. Ten or 15 years ago, it “wasn’t at all uncommon” for insurance plans to exclude mental health services from coverage altogether, King said.

“If you don’t have coverage for mental health treatment, you’re excluding a huge percentage of the population from getting access to the treatment they need,” King said.

Lisa S. Kantor, an attorney with Kantor & Kantor LLP in Northridge, Calif., who represents patients with eating disorders, said the law has greatly benefited her clients.

“Requiring parity between mental health and medical/surgical benefits has opened access to levels of treatment and length of stays that were previously unavailable,” Kantor told Bloomberg BNA in an email. “The Act has literally saved lives.”

Dr. Bryn Austin, president of the Eating Disorders Coalition, echoed that sentiment. “With one person losing their life every 62 minutes as a direct result of an eating disorder, it is undeniable that Senator Domenici’s legacy will be that of saving lives through mental health parity,” Austin said in a statement.

Crossing the Aisle

Jordan Lewis, a Fort Lauderdale, Fla.-based attorney who has filed several class actions against insurers seeking coverage for mental health treatments, said the MHPAEA was an example of how the system is supposed to work. Lewis also praised one of the act’s other driving forces—the late Paul Wellstone, the Democratic U.S. senator from Minnesota who died six years before the law’s passage.

Despite “deep and sincere political differences on a host of issue,” Wellstone and Domenici were drawn together to create an “incredibly important civil rights law, Lewis said.

“I don’t consider the Act an insurance statute, but one of civil rights, and, from what I’ve read, so did Wellstone and Domenici,” Lewis told Bloomberg BNA in an email. “They were both motivated to this cause because of what they learned through their own families, which makes it, I think, an example of how, and why, the system is supposed to work.”

To contact the reporter on this story: Jacklyn Wille in Washington at jwille@bna.com

To contact the editor responsible for this story: Jo-el J. Meyer at jmeyer@bna.com

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